Does autologous blood transfusion during liver transplantation for hepatocellular carcinoma increase risk of recurrence?

Table 1 Clinicopathological distribution according to the use of autologous intraoperative blood salvage for patients with hepatocellular carcinoma who underwent liver transplantation

	Total (%) n = 158	Intraoperative blood salvage		P
		Yes (%) n = 122 (77.2)	No (%) n = 36 (22.8)
Age1	58 (51-62)	58 (51-62)	58 (51-62)	0.958
Male gender	122 (77.2)	95 (77.9)	27 (75)	0.821
BMI12	25.7 (23.6-27.8)	25.7 (23.6-27.8)	25.5 (23.5-2.3)	0.712
Pre-op AFP3	9.2 (3.7-35.4)	8.9 (3.5-3.6)	10.9 (6.7-33.7)	0.175
Cirrhosis4	135 (88.3)	100 (84.8)	35 (100)	0.014
Alcohol4	22 (14.4)	18 (15.3)	4 (11.4)	0.785
Hepatitis4
B	20 (13.1)	12 (10.2)	8 (22.9)	0.082
C	97 (63.4)	73 (61.9)	24 (68.6)	0.551
Others4	8 (5.2)	8 (6.8)	0	0.199
Blood type				0.420
A	60 (37)	42 (34.4)	18 (50)
B	21 (13.3)	17 (13.9)	4 (11.1)
AB	14 (8.9)	11 (9)	3 (8.3)
O	63 (39.9)	52 (42.6)	11 (30.6)
Rhesus5	123 (86.6)	93 (86.1)	30 (88.3)	1.000
MELD1	10 ( 8-15)	10.5 (9-17)	9 (8-13.5)	0.058
Radiofrequency4	4 (2.6)	3 (2.6)	1 (2.8)	1.000
Chemoembolization4	69 (45.1)	53 (45.3)	16 (44.5)	1.000
Alcoholization4	7 (4.6)	5 (4.3)	2 (5.6)	0.668
Graft/body proportion12	1.75 (1.5-2.2)	1.8 (1.5-2.2)	1.7 (1.4– 2.2)	0.454
Number of lesions1	2 (1-3)	2 (1-3)	2 (1-3)	0.715
Largest lesion, mm1	25 (19-31)	25 (19-30)	25 (18-35)	0.384
Edmond-steiner degree (III and IV)6	88 (59.9)	67 (58.8)	21 (63.5)	0.689
Vascular invasion	53 (33.6)	44 (36.1)	9 (25)	0.236
Microsatellite lesions	26 (16.5)	19 (15.6)	7 (19.4)	0.612
Cholangiocarcinoma	6 (3.8)	6 (4.9)	0	0.338
Recurrence	14 (8.9)	10 (8.2)	4 (11.1)	0.525
Death	52 (32.9)	41 (33.6)	11 (30.6)	0.841

¹Expressed as median (p25-p75);

²N = 150;

³N = 148;

⁴N = 153;

⁵N = 142;

⁶N = 147. BMI: Body mass index; AFP: Alpha-feto protein; MELD: Model of end-stage liver disease.

Table 2 Univariate and multivariate analyses for predictors of overall survival

	Total	5-yr survival (%)	Median survival (mo)	Univariate analysis P	HR	95%CI	Multivariate analysis P
Overall	158	59.7	-	-
Age (≥ 60 yr)	-	-	-	0.133
Gender		-	-	0.097
Male	122	61.5			0.88	0.45-1.74	0.714
Female	36	55.4	-
BMI (≥ 28)				0.080
Yes	37	48.2	46		1.55	0.81-2.98	0.186
No	113	63.6	-
Pre-op AFP (≥ 100 ng/dL)				0.087
Yes	19	51.8	-		1.50	0.68-3.32	0.316
No	129	60.8	-
Cirrhosis	-	-	-	0.950
Alcohol related				0.048
Yes	22	86.4	-		0.30	0.09-1	0.051
No	131	55.5	-
Hepatitis B infection	-	-	-	0.156
Hepatitis C infection	-	-	-	0.130
Others	-	-	-	0.281
Blood type	-	-	-	0.470
Rhesus	-	-	-	0.554
Radiofrequency	-	-	-	0.821
MELD (≥ 15)	-	-	-	0.721
Chemo-embolization	-	-	-	0.877
Tumor alcoholization	-	-	-	0.118
Graft/body % (≥ 2)	-	-	-	0.163
No. of lesions (> 3)	-	-	-	0.819
Largest lesion (≥ 30 mm)	-	-	-	0.640
Edmond-Steiner degree				0.013
III-IV	88	48.9	51		2.19	1.07-4.47	0.031
0-II	59	74.4	-
Vascular invasion	-	-	-	0.290
Microsatellite lesions	-	-	-	0.283
Cholangiocarcinoma	-	-	-	0.957
IBS				0.510
Yes	122	59.5	-		1.56	0.74-3.30	0.237
No	36	64.5	-

BMI: Body mass index; AFP: Alpha-feto protein; IBS: Intraoperative blood salvage; MELD: Model of End-Stage Liver Disease. The number of patients included in multivariate model is 141.

Table 3 Univariate analysis for predictors of recurrence

	Total	5-yr survival (%)	Median survival (mo)	Univariate analysis P
Overall	158	83.3	-	-
Age (≥ 60 yr)	-	-	-	0.319
Male gender	-	-	-	0.410
BMI (≥ 28)	-	-	-	0.166
Pre-op AFP (≥ 100 mg/dL)				0.001
Yes	19	59.4	84.5
No	129	85	-
Cirrhosis	-	-	-	0.163
Alcohol related	-	-	-	0.207
Hepatitis B infection	-	-	-	0.911
Hepatitis C infection	-	-	-	0.568
Others	-	-	-	0.794
Blood type	-	-	-	0.912
Rhesus	-	-	-	0.494
MELD (≥ 15)	-	-	-	0.694
Radiofrequency	-	-	-	0.758
Chemoembolization	-	-	-	0.133
Tumor alcoholization	-	-	-	0.373
Graft/body % (≥ 2)	-	-	-	0.605
Number of lesions (> 3)	-	-	-	0.496
Largest lesion mm (≥ 30)	-	-	-	0.429
Edmond-Steiner degree				0.0162
III-IV	88	73	84.5
0-II	59	94.3	-
Vascular invasion				0.071
Yes	26	74.8	84.5
No	132	86.3	-
Microsatellite lesions				0.007
Yes	26	-	-
No	132	86.5	-
Cholangiocarcinoma	-	-	-	0.375
IBS				0.953
Yes	122	85	84.5
No	36	78.8	-

BMI: Body mass index; AFP: Alpha-feto protein; IBS: Intraoperative blood salvage; MELD: Model of End-Stage Liver Disease.